Re-interpreting the response to cardiac resynchronization therapy and options for improving therapeutic efficacy

Abstract

Currently, there is no widely accepted criterion for judging the efficacy of CRT treatment. Patients underwent CRT implantation have most often been classified as either responders or non-responders based on the occurrence or absence of reverse remodelling following CRT. Based on this definition, nearly one-third of patients are considered as non-responders with a less favourable prognosis compared to responders. Recent recommendations have revised the previous terminologies. Accordingly, the CRT non-responder definition have-been re-defined as those who deteriorate (progressors) and remain stable for years (non-progressor) after CRT implantation. Considering the progressive nature of HF, non-progression could still represent a response to the device therapy and thereby classifying these patients as non-responders might be misleading. The background of the suboptimal CRT response is multifactorial, requiring a multidisciplinary approach for improving the effectiveness of CRT treatment. Therefore, we care must be taken on the appropriate patient selection and optimisation of the medications prior to implantation, currently available technical options and innovations during the intervention, device optimisation post-implantation, as well as on the management of comorbidities.

Keywords

• cardiac resynchronisation therapy
• responder
• non-responder
• progressor
• non-progressor